Form JV-068 "Guardian Ad Litem's Certificate of Services" - Massachusetts

What Is Form JV-068?

This is a legal form that was released by the Massachusetts Juvenile Court Department - a government authority operating within Massachusetts. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 6, 2015;
  • The latest edition provided by the Massachusetts Juvenile Court Department;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form JV-068 by clicking the link below or browse more documents and templates provided by the Massachusetts Juvenile Court Department.

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Download Form JV-068 "Guardian Ad Litem's Certificate of Services" - Massachusetts

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DOCKET NUMBER
GUARDIAN AD LITEM'S
Trial Court of Massachusetts
CERTIFICATE OF SERVICES Page 1
Juvenile Court Department
VENDOR CODE NUMBER
CASE NAME
DIVISION
NAME & ADDRESS OF GUARDIAN AD LITEM
NAME OF APPOINTING JUSTICE
TELEPHONE NUMBER:
CERTIFICATION OF GUARDIAN AD LITEM
I certify under the pains and penalties of perjury:
that I have performed the services described in the attached Guardian Ad Litem Itemization of
Services, that the services and time were necessary and were within the scope of the services for
which I have been appointed, and that, where applicable, I have filed the original report with the Court
as required.
I further certify that I
have
have not previously billed for services provided within the scope
of this appointment.
If applicable, please complete.
No. of Hours billed:
Amount billed: $
DATE
SIGNATURE OF GUARDIAN AD LITEM
CERTIFICATION OF JUSTICE
I have reviewed and approve as appropriate the above named Guardian Ad Litem's attached
itemization of services for payment.
DATE
SIGNATURE OF JUSTICE
JV-068 (Rev. 07/06/2015)
DOCKET NUMBER
GUARDIAN AD LITEM'S
Trial Court of Massachusetts
CERTIFICATE OF SERVICES Page 1
Juvenile Court Department
VENDOR CODE NUMBER
CASE NAME
DIVISION
NAME & ADDRESS OF GUARDIAN AD LITEM
NAME OF APPOINTING JUSTICE
TELEPHONE NUMBER:
CERTIFICATION OF GUARDIAN AD LITEM
I certify under the pains and penalties of perjury:
that I have performed the services described in the attached Guardian Ad Litem Itemization of
Services, that the services and time were necessary and were within the scope of the services for
which I have been appointed, and that, where applicable, I have filed the original report with the Court
as required.
I further certify that I
have
have not previously billed for services provided within the scope
of this appointment.
If applicable, please complete.
No. of Hours billed:
Amount billed: $
DATE
SIGNATURE OF GUARDIAN AD LITEM
CERTIFICATION OF JUSTICE
I have reviewed and approve as appropriate the above named Guardian Ad Litem's attached
itemization of services for payment.
DATE
SIGNATURE OF JUSTICE
JV-068 (Rev. 07/06/2015)
DOCKET NUMBER
Trial Court of Massachusetts
GUARDIAN AD LITEM'S
ITEMIZATION OF SERVICES Page
of
2
Juvenile Court Department
VENDOR CODE NUMBER
CASE NAME
DIVISION
ITEMIZATION OF SERVICES
(shall not include travel, court waiting time nor time for preparation of this form)
ATTACH THE FOLLOWING: A COPY OF APPOINTMENT AND A COPY OF ANY APPROVED MOTION(S). FAILURE TO PROVIDE THE
REQUIRED ATTACHMENTS WILL DELAY PROCESSING OF THIS FORM FOR PAYMENT.
DATE OF
START TIME/
TIME SPENT
DESCRIPTION OF WORK
SERVICE
END TIME
(In Minutes)
(Please Specify)
Total Minutes Divided by 60 =
Hours
Total Minutes:
X $50.00 per hour = Total Amount: $
DATE
SIGNATURE OF GUARDIAN AD LITEM
PRINT NAME
JV-068 (Rev. 07/06/2015)
DOCKET NUMBER
Trial Court of Massachusetts
GUARDIAN AD LITEM'S
ITEMIZATION OF SERVICES Page
of
3
Juvenile Court Department
VENDOR CODE NUMBER
CASE NAME
DIVISION
ITEMIZATION OF SERVICES
(shall not include travel, court waiting time nor time for preparation of this form)
ATTACH THE FOLLOWING: A COPY OF APPOINTMENT AND A COPY OF ANY APPROVED MOTION(S). FAILURE TO PROVIDE THE
REQUIRED ATTACHMENTS WILL DELAY PROCESSING OF THIS FORM FOR PAYMENT.
DATE OF
START TIME/
TIME SPENT
DESCRIPTION OF WORK
SERVICE
END TIME
(In Minutes)
(Please Specify)
Total Minutes Divided by 60 =
Hours
Total Minutes:
X $50.00 per hour = Total Amount: $
DATE
SIGNATURE OF GUARDIAN AD LITEM
PRINT NAME
JV-068 (Rev. 07/06/2015)
DOCKET NUMBER
Trial Court of Massachusetts
GUARDIAN AD LITEM'S
ITEMIZATION OF SERVICES Page
of
4
Juvenile Court Department
VENDOR CODE NUMBER
CASE NAME
DIVISION
ITEMIZATION OF SERVICES
(shall not include travel, court waiting time nor time for preparation of this form)
ATTACH THE FOLLOWING: A COPY OF APPOINTMENT AND A COPY OF ANY APPROVED MOTION(S). FAILURE TO PROVIDE THE
REQUIRED ATTACHMENTS WILL DELAY PROCESSING OF THIS FORM FOR PAYMENT.
DATE OF
START TIME/
TIME SPENT
DESCRIPTION OF WORK
SERVICE
END TIME
(In Minutes)
(Please Specify)
Total Minutes Divided by 60 =
Hours
Total Minutes:
X $50.00 per hour = Total Amount: $
DATE
SIGNATURE OF GUARDIAN AD LITEM
PRINT NAME
JV-068 (Rev. 07/06/2015)
Page of 4